This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nunn, C. M. Search for Related Content PubMed PubMed Citation Articles by Nunn, C. M.

CLINICAL STUDIES

Long-term outcome after primary angioplasty: report from the Primary Angioplasty in Myocardial Infarction (PAMI-I) trial

Christopher M. Nunn, MBChB, FRACP^*, William W. O’Neill, MD, FACC, Donald Rothbaum, MD, FACC, Gregg W. Stone, MD, FACC, James O’Keefe, MD, FACC^||, Paul Overlie, MD, FACC^¶, Bryan Donohue, MD, FACC^#, Lorelei Grines, PhD^{* || ¶ # **}, Kevin F. Browne, MD, FACC^**, Ronald E. Vlietstra, MD, FACC^**, Tom Catlin, Cindy L. Grines, MD, FACC For The Primary Angioplasty in Myocardial Infarction I Study Group^*

^* Division of Cardiology, Waikato Hospital, Hamilton, New Zealand
Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
Division of Cardiology, St. Vincent Hospital, Indianapolis, Indiana, USA
Division of Cardiology, El Camino Hospital, Mountain View, California, USA
^|| Division of Cardiology, Mid American Heart Institute, Kansas City, Missouri, USA
^¶ Division of Cardiology, St. Mary of the Plains, Lubbock, Texas, USA
^# Division of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
^** Division of Cardiology, Lakeland Regional Medical Center, Lakeland, Florida, USA

Manuscript received July 17, 1998; revised manuscript received October 15, 1998, accepted November 20, 1998.

Reprint requests and correspondence: Dr. C. M. Nunn, Department of Cardiology, Waikato Hospital, Private Bag 3200, Hamilton, New Zealand

OBJECTIVES

This study sought to compare the two-year outcome after primary percutaneous coronary angioplasty or thrombolytic therapy for acute myocardial infarction.

BACKGROUND

Primary angioplasty, that is, angioplasty without antecedent thrombolytic therapy, has been shown to be an effective reperfusion modality for patients suffering an acute myocardial infarction. This report reviews the two-year clinical outcome of patients randomized in the Primary Angioplasty in Myocardial Infarction trial.

METHODS

At 12 clinical centers, 395 patients who presented within 12 h of the onset of myocardial infarction were randomized to undergo primary angioplasty (195 patients) or to receive tissue-type plasminogen activator (t-PA) (200 patients) followed by conservative care. Patients were followed by physician visits, phone call, letter and review of hospital records for any hospital admission at one month, six months, one year and two years.

RESULTS

At two years, patients undergoing primary angioplasty had less recurrent ischemia (36.4% vs. 48% for t-PA, p = 0.026), lower reintervention rates (27.2% vs. 46.5% for t-PA, p < 0.0001) and reduced hospital readmission rates (58.5% vs. 69.0% for t-PA, p = 0.035). The combined end point of death or reinfarction was 14.9% for angioplasty versus 23% for t-PA, p = 0.034. Multivariate analysis found angioplasty to be independently predictive of a reduction in death, reinfarction or target vessel revascularization (p = 0.0001).

CONCLUSIONS

The initial benefit of primary angioplasty performed by experienced operators is maintained over a two-year follow-up period with improved infarct-free survival and reduced rate of reintervention.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CABG = coronary artery bypass surgery   GUSTO = Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries   PAMI = Primary Angioplasty in Myocardial Infarction   TIMI = Thrombolysis in Myocardial Infarction   t-PA = tissue-type plasminogen activator   TVR = target vessel revascularization

This article has been cited by other articles:

				T. Huynh, S. Perron, J. O'Loughlin, L. Joseph, M. Labrecque, J. V. Tu, and P. Theroux Comparison of Primary Percutaneous Coronary Intervention and Fibrinolytic Therapy in ST-Segment-Elevation Myocardial Infarction: Bayesian Hierarchical Meta-Analyses of Randomized Controlled Trials and Observational Studies Circulation, June 23, 2009; 119(24): 3101 - 3109. [Abstract] [Full Text] [PDF]

				C P Gale, S O M Manda, P D Batin, C F Weston, J S Birkhead, and A S Hall Predictors of in-hospital mortality for patients admitted with ST-elevation myocardial infarction: a real-world study using the Myocardial Infarction National Audit Project (MINAP) database Heart, November 1, 2008; 94(11): 1407 - 1412. [Abstract] [Full Text] [PDF]

				S. G. Goodman, V. Menon, C. P. Cannon, G. Steg, E. M. Ohman, and R. A. Harrington Acute ST-Segment Elevation Myocardial Infarction: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 708S - 775S. [Abstract] [Full Text] [PDF]

				M. Busk, M. Maeng, K. Rasmussen, H. Kelbaek, P. Thayssen, U. Abildgaard, E. Vigholt, L. S. Mortensen, L. Thuesen, S. D. Kristensen, et al. The Danish multicentre randomized study of fibrinolytic therapy vs. primary angioplasty in acute myocardial infarction (the DANAMI-2 trial): outcome after 3 years follow-up Eur. Heart J., May 2, 2008; 29(10): 1259 - 1266. [Abstract] [Full Text] [PDF]

				V. J. Dzau, E. M. Antman, H. R. Black, D. L. Hayes, J. E. Manson, J. Plutzky, J. J. Popma, and W. Stevenson The Cardiovascular Disease Continuum Validated: Clinical Evidence of Improved Patient Outcomes: Part II: Clinical Trial Evidence (Acute Coronary Syndromes Through Renal Disease) and Future Directions Circulation, December 19, 2006; 114(25): 2871 - 2891. [Full Text] [PDF]

				G Parodi, G Memisha, R Valenti, M Trapani, A Migliorini, G M Santoro, and D Antoniucci Five year outcome after primary coronary intervention for acute ST elevation myocardial infarction: results from a single centre experience Heart, December 1, 2005; 91(12): 1541 - 1544. [Abstract] [Full Text] [PDF]

				Part 5: Acute Coronary Syndromes Circulation, November 29, 2005; 112(22_suppl): III-55 - III-72. [Full Text] [PDF]

				Reperfusion in acute myocardial infarction DTB, July 1, 2005; 43(7): 49 - 53. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, S. Silber, P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, J. Marco, J.-E. Nordrehaug, et al. Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology Eur. Heart J., April 2, 2005; 26(8): 804 - 847. [Full Text] [PDF]

				V. Menon, R. A. Harrington, J. S. Hochman, C. P. Cannon, S. D. Goodman, R. G. Wilcox, H. J. Schunemann, and E. M. Ohman Thrombolysis and Adjunctive Therapy in Acute Myocardial Infarction: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 549S - 575S. [Abstract] [Full Text] [PDF]

				E. C. Keeley and C. L. Grines Primary Percutaneous Coronary Intervention for Every Patient with ST-Segment Elevation Myocardial Infarction: What Stands in the Way? Ann Intern Med, August 17, 2004; 141(4): 298 - 304. [Abstract] [Full Text] [PDF]

				I. A. Khan Initial Therapy for Acute Myocardial Infarction in the Real World Chest, August 1, 2004; 126(2): 331 - 333. [Full Text] [PDF]

				G. M. Tadros, M. A. Islam, A. Mirza, J. C. Blankenship, and E. A. Iliadis Angiographic and Long-Term Outcomes of "Rescue" Stenting versus PTCA in Failed Thrombolysis in Acute Myocardial Infarction Angiology, March 1, 2004; 55(2): 169 - 176. [Abstract] [PDF]

				L F Hsu, K H Mak, K W Lau, L L Sim, C Chan, T H Koh, S C Chuah, R Kam, Z P Ding, W S Teo, et al. Clinical outcomes of patients with diabetes mellitus and acute myocardial infarction treated with primary angioplasty or fibrinolysis Heart, September 1, 2002; 88(3): 260 - 265. [Abstract] [Full Text] [PDF]

				N. J. Goswami, J. M. Moody Jr, and S. R. Bailey Percutaneous Mechanical Reperfusion During Acute Myocardial Infarction J Intensive Care Med, July 1, 2002; 17(4): 162 - 173. [Abstract] [PDF]

				T. Aversano, L. T. Aversano, E. Passamani, G. L. Knatterud, M. L. Terrin, D. O. Williams, S. A. Forman, and for the Atlantic Cardiovascular Patient Outcomes R Thrombolytic Therapy vs Primary Percutaneous Coronary Intervention for Myocardial Infarction in Patients Presenting to Hospitals Without On-site Cardiac Surgery: A Randomized Controlled Trial JAMA, April 17, 2002; 287(15): 1943 - 1951. [Abstract] [Full Text] [PDF]

				D. Bonderman, A. Teml, J. Jakowitsch, C. Adlbrecht, M. Gyongyosi, W. Sperker, H. Lass, W. Mosgoeller, D. H. Glogar, P. Probst, et al. Coronary no-reflow is caused by shedding of active tissue factor from dissected atherosclerotic plaque Blood, April 15, 2002; 99(8): 2794 - 2800. [Abstract] [Full Text] [PDF]

				G. W. Stone, C. L. Grines, D. A. Cox, E. Garcia, J. E. Tcheng, J. J. Griffin, G. Guagliumi, T. Stuckey, M. Turco, J. D. Carroll, et al. Comparison of Angioplasty with Stenting, with or without Abciximab, in Acute Myocardial Infarction N. Engl. J. Med., March 28, 2002; 346(13): 957 - 966. [Abstract] [Full Text] [PDF]

				C Loubeyre, T Lefevre, Y Louvard, P Dumas, J.-F Piechaud, J.-J Lanore, J.-F Angellier, J.-Y Le Tarnec, G Karrillon, A Margenet, et al. Outcome after combined reperfusion therapy for acute myocardial infarction, combining pre-hospital thrombolysis with immediate percutaneous coronary intervention and stent Eur. Heart J., July 1, 2001; 22(13): 1128 - 1135. [Abstract] [PDF]

				P. Widimsky Pharmacological versus catheter-based reperfusion: What is present state of the art? Eur. Heart J. Suppl., June 1, 2001; 3(suppl_C): C47 - C54. [Abstract] [PDF]

				M. R. Le May, M. Labinaz, R. F. Davies, J.-F. Marquis, L. A. Laramee, E. R. O'Brien, W. L. Williams, R. S. Beanlands, G. Nichol, and L. A. Higginson Stenting versus thrombolysis in acute myocardial infarction trial (STAT) J. Am. Coll. Cardiol., March 15, 2001; 37(4): 985 - 991. [Abstract] [Full Text] [PDF]

				M. B Patel, K. S Kilgore, G. A Ortolano, C. L Gryboski, M. A Qureshi, P. Marcovitz, K. B Naylor, J. L Park, B. Wenz, N. Gikakis, et al. Conditioned blood reperfusion during angioplasty (CoBRA) treatment of acute myocardial infarction Perfusion, January 1, 2001; 16(1_suppl): 39 - 49. [Abstract] [PDF]

				A. Schomig, A. Kastrati, J. Dirschinger, J. Mehilli, U. Schricke, J. Pache, S. Martinoff, F.-J. Neumann, M. Schwaiger, and The Stent versus Thrombolysis for Occluded Coronar Coronary Stenting plus Platelet Glycoprotein IIb/IIIa Blockade Compared with Tissue Plasminogen Activator in Acute Myocardial Infarction N. Engl. J. Med., August 10, 2000; 343(6): 385 - 391. [Abstract] [Full Text] [PDF]

				N. M Robinson and A. D Timmis Reperfusion in acute myocardial infarction BMJ, May 20, 2000; 320(7246): 1354 - 1355. [Full Text]

				J. W. Kennedy Thrombolytic therapy in acute myocardial infarction J. Am. Coll. Cardiol., April 1, 2000; 35(5_Suppl_B): 25B - 28B. [PDF]

				Tackling myocardial infarction DTB, March 1, 2000; 38(3): 17 - 22. [Abstract] [Full Text] [PDF]

				J. W. Kennedy Thrombolytic therapy in acute myocardial infarction J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1829 - 1832. [Abstract] [Full Text] [PDF]